Department of Surgery, One Boston Medical Center Drive, Boston University School of Medicine, Collamore 501, Boston, MA, 02118, USA.
Hernia. 2021 Jun;25(3):673-677. doi: 10.1007/s10029-020-02243-1. Epub 2020 Jun 3.
Ventral hernia repair is common in the expanding aging population, but remains challenging due to their frequent comorbidities. The purpose of this study is to compare the surgical outcomes of open vs. laparoscopic ventral hernia repair in elderly patients.
Patients ≥ 65 years of age that underwent elective open or laparoscopic ventral hernia repair were identified from the American College of Surgeons National Surgical Quality Improvement Project (NSQIP) database. To reduce potential selection bias, propensity scores were created for the likelihood of undergoing laparoscopic surgery based on patients' demographics and comorbidities. Patients were matched based on the logit of the propensity scores. Thirty-day surgical outcomes were compared after matching using Chi-square test for categorical variables and the Wilcoxon Rank-Sum test for continuous variables.
35,079 (71.1%) and 14,270 (28.9%) patients underwent open and laparoscopic ventral hernia repairs, respectively. Laparoscopic surgery was associated with a lower overall morbidity (5.9% vs. 9.1%; p < 0.001) compared to open repair. The incidence of surgical site infections (1.1% vs. 3.5%; p < 0.001), post-operative infections (2.7% vs. 3.6%; p < 0.001), and reoperation (1.7% vs. 2.1%; p = 0.009) were all lower after laparoscopic repair. All other major surgical outcomes were either better with laparoscopy or comparable between both treatment groups except for operative time.
Although open surgery remains the most prevalent in the elderly population, the results of this study suggest that laparoscopic surgery is safe and associated with a lower risk of overall morbidity, surgical site infections, and reoperation.
随着老龄化人口的不断增加，腹壁疝修补术越来越常见，但由于老年患者常合并多种疾病，手术治疗仍具有挑战性。本研究旨在比较开放手术与腹腔镜腹壁疝修补术治疗老年患者的手术效果。
从美国外科医师学会国家外科质量改进计划（NSQIP）数据库中筛选出年龄≥65 岁且接受择期开放或腹腔镜腹壁疝修补术的患者。为了降低潜在的选择偏倚，根据患者的人口统计学特征和合并症，创建了腹腔镜手术的倾向评分，以评估行腹腔镜手术的可能性。基于倾向评分的对数，采用卡方检验比较分类变量，采用 Wilcoxon 秩和检验比较连续变量，对患者进行匹配。匹配后，采用卡方检验比较 30 天手术结果。
35079 例（71.1%）和 14270 例（28.9%）患者分别接受了开放和腹腔镜腹壁疝修补术。与开放修补术相比，腹腔镜手术的总体并发症发生率较低（5.9% vs. 9.1%；p<0.001）。腹腔镜修补术后手术部位感染（1.1% vs. 3.5%；p<0.001）、术后感染（2.7% vs. 3.6%；p<0.001）和再次手术（1.7% vs. 2.1%；p=0.009）的发生率均较低。除手术时间外，腹腔镜组的其他主要手术结局均优于开放组或与开放组相当。
尽管开放手术在老年人群中仍最为常见，但本研究结果表明，腹腔镜手术安全，且总体并发症、手术部位感染和再次手术的风险较低。
